Half of London's doctors haven't heard of STPs, survey finds

 BMA press release, 01 November 2016

More than half of doctors in London have not heard of sustainability and transformation plans (STPs) due to be published by the end of this year, a BMA survey shows.

Of the 615 consultants and GPs surveyed, a majority (59 per cent)  said they had not heard of STPs - five year plans detailing how areas will work together to implement NHS England’s Five Year Forward View.

The BMA asked GPs and consultants in London about their involvement in the creation of the four STPs footprints for the city, made up of clinical commissioning groups (CCGs), local authorities, NHS trusts and other health and care organisations. 

When asked if doctors felt they could influence decisions made by their clinical commissioning group (CCG), more than four in five (82 per cent) said they did not feel they could, even though CCGs are membership organisations. 

The BMA believes that STPs could provide opportunities for collaboration and longer-term planning, but have concerns that they are an inadequate response to the real crisis, that of the long-term underfunding of patient care.The survey’s findings also raise questions about the involvement of doctors and medical professionals in STPs and a lack of understanding of STPs, which require NHS trusts to be financially balanced by 2020. 

Some of the key findings among the consultants surveyed were: 

•    53 per cent have not heard of STPs
•    85 per cent have not had any information about STPs from their Trust
•    88 per cent felt they were unable to influence decisions made by their CCG
•    93 per cent felt they have not had enough information about how health services are being devolved in pilot areas
•    73 per cent do not know if devolution is happening in their area

 Some of the key findings among London’s GPs were: 

•    66 per cent have not heard of STPs
•    87 per cent were not formally consulted about the STP
•    76 per cent felt they were unable to influence decisions made by their CCG
•    61 per cent did not know how to challenge or change the leadership of their CCG

Commenting on the findings, Dr Gary Marlowe, BMA London regional council chair, said:

“Local authorities in London including Camden1 and Sutton2 councils have felt they must publish their draft STP documents because of the lack of public, patient and political involvement and full transparency. The realities of no clear vision for health and social care in London are setting in, with one in five London GP surgeries facing closure in the next three years3 and several London NHS trusts have been placed in special measures4.

“It is extremely concerning that more than half of doctors surveyed didn’t know about STPs. Of those who are aware, many are concerned this is merely a means of delivering cuts to NHS services, though some others see this as an opportunity for localised long-term strategic planning in health. 

“The difficulty is that doctors haven’t been told enough about STPs to fully understand their impact and to decide if their concerns have been addressed.

"As we’ve seen in the debate over NHS funding in recent days, many services are at risk of financial collapse and meaningful input into STPs from clinicians, who understand what is happening on the front line, is essential. 

“The BMA is encouraging doctors to seek contact with their STP lead and to find out more about what’s happening locally but NHS providers, CCGs, local authorities and other health and care services must work harder to engage medical professionals if they are seeking support for their efforts.”


2 https://www.sutton.gov.uk/info/200333/adult_health_and_social_care/1586/sw_london_sustainability_and_transformation_plan_stp




Plan to 'transform' NHS could lead to downgrade of major London hospitals

Council leaders refuse to back proposal amid fears Ealing and Charing Cross hospitals could lose A&E and other services as focus shifts to ‘virtual’ care



NHS Strategic Projects Team to be closed down

England NHS multimillion-pound contract consultants axed


21 July 2016

An "award winning" team of business consultants linked to a series of failed multi million-pound NHS deals is to be scrapped.

The Strategic Projects Team, which boasts of delivering "over £6bn of major projects," was set up to deliver the first franchise-run NHS Hospital.

NHS England has now raised "real concerns" about its work, saying the unit will be "closed down".

The team (SPT) says it intends to "eventually" complete the projects.

Formed in 2009, it has previously worked on huge contracts like the Hinchingbrooke Hospital franchise - the first deal of its kind - and the five-year £800m UnitingCare contract for older people's service in Cambridgeshire. The unit, which currently sits under the control of the Arden & Greater East Midlands Commissioning Support Unit (CSU), also worked on the NHS Friends and Family Test, a patient ratings system aimed at improving nursing care. It has previously been honoured for its work at the Independent Healthcare Awards and Health Investor Awards.

Hinchingbrooke Hospital, Huntingdon

The Hinchingbrooke Hospital scheme was the first ever franchise arrangement for an NHS hospital

What happened to SPT's major projects:

* Hinchingbrooke Hospital, Huntingdon:

What the SPT says: Hinchingbrooke was "the first ever franchise of an NHS Hospital" and the SPT's "dedicated communications team provided in-depth support"

What happened: Circle withdrew from the project three years into a ten year contract, saying the franchise was "no longer viable". The decision came after the Care Quality Commission placed the hospital in special measures.

* UnitingCare:

What they say: The SPT was one of a number of suppliers supporting the "innovative" project - a tender worth up to £800m over five years. Following the collapse of the scheme, the SPT said it had completed a "successful association" with UnitingCare, adding "while there may inevitably be some learning from a future inquiry... we remain proud of the contribution we made to yet another ground breaking piece of work"

What happened: The contract collapsed after just eight months after UnitingCare said it was not "financially sustainable".

* George Elliot Hospital, Nuneaton

What they say: The SPT "delivered an exemplary service" during a complex procurement process, providing "hard work, diligence and strategic insight".

What happened: Following significant improvements in clinical performance, the decision was made not to pursue the procurement process

* Weston Hospital, Weston-super-Mare

What they say: The SPT will "lead activities" to "achieve a sustainable future and reach Foundation Trust status".

What happened: A deal which would have seen Weston taken over by the neighbouring Taunton and Somerset NHS Foundation Trust was dropped as it "did not represent a sustainable future".

* The Pathology Partnership

What they say: The SPT became involved in the East of England pathology network in 2010 to "prepare the ground for change".

What happened: Cambridge University Hospital NHS Foundation Trust "intends to withdraw" from the partnership over the next 12 months.

* Staffordshire cancer and end of life contracts

What they say: The SPT is working with CCGs "to transform the way people with cancer, and those at the end of their life are cared for and supported". The project has been awarded NHS Pioneer status.

What happened: The project has been put on hold pending the outcome "of the independent review" into UnitingCare.

The Hinchingbrooke deal collapsed when Circle pulled out of its 10-year contract in January 2015 - just three years after it began.

Following the launch of a series of reviews into the failings at UnitingCare, other projects involving the SPT were put on hold.

These reviews have now led to the SPT being scrapped.


Analysis by Tom Barton, Political Reporter, BBC Look East

The Strategic Projects Team was at the heart of negotiating a number of flagship NHS contracts. The appointment of private provider Circle Health to run Hinchingbrooke Hospital is the most famous - while the £800m UnitingCare contract to deliver healthcare for older people in Cambridgeshire was the biggest. Both of these fell apart - and a number of other projects collapsed or were abandoned at various stages.

On their website, the SPT says it "supports projects which are often complex, hugely challenging and require a relentless work ethic".

So have some of the projects have been too complex and challenging - or has the support not been good enough? NHS England are clear that they have "real concerns" about the work done.

The other big question is whether the demise of the SPT suggests the NHS in England is losing enthusiasm for big outsourcing projects like Hinchingbrooke and UnitingCare.

I'm told no ministers were involved in the decision to close the unit - so there hasn't been a change in government policy. But given the involvement of the SPT in so many of the biggest contracts - who inside the NHS now has the experience to carry on their work in the future?

A senior manager inside one collapsed SPT project said his main issue had been "their total refusal to acknowledge reality".

They "stuck doggedly to rules" and a "silly" timetable, meaning "honest discussions couldn't take place until too late".

"Any fool could've seen from the start that the competing regulatory requirements meant the project was doomed," he added.

"Had the SPT been willing to listen we could've found a much better solution.

'Catastrophic misunderstanding'

Last week, an investigation into UnitingCare by the National Audit Office(NAO) criticised the planning and lack of data setting out the true cost of the service.

The report said the SPT, which was paid £292,700, failed to include advice on the need to secure performance guarantees in the text of its evaluation of the contract. As a result, Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) had not sought such a guarantee.

Speaking at the time, Cambridge MP Daniel Zeichner said the report was "particularly critical" of the SPT, which he called "the outriders for NHS privatisation".

Daniel Zeichner MP

The failing is also noted in the CCG's own report on the way the contracts were handled.

An NHS England review into UnitingCare, published in April, said the SPT had been retained to assist the CCG "in ensuring success with the process," but that a "number of flaws" were identified.

A second NHS England review is expected to take a closer look at the role of the SPT and other contractors. This is yet to be published.

'Some anxiety'

A spokesman for NHS England said: "In the light of recent NAO and NHS England investigations we have real concerns about the work of the Strategic Projects Team, which as a result is going to be closed down as an offshoot of the Arden and GEM CSU."

The SPT's managing director Andrew MacPherson, said the unit had been "seeking an alternative host" since September.

He said the end of the UnitingCare contract had created "some anxiety" with the SPT "concerned we were becoming the story".

He added the team intends to ensure existing commitments are "fully discharged to completion" and its expertise is properly redistributed.


Professor Keith McNeil to be the first NHS Chief Clinical Information Officer

Dr Keith McNeil, Addenbrooke's Hospital


On 7th July the NHS announced the appointment of Professor Keith McNeil as the NHS's first Chief Clinical Information Officer, responsible as senior medical leader for introducing new electronic hospital records in all hospitals trusts of England and Wales. He will be supported by a Chief Information Officer, Will Smart, currently Chief Information Officer at the Royal Free London NHS Foundation Trust. Mr Smart has had an extensive career in IT across the NHS and in the private sector.


Professor Keith McNeil was the CEO of Addenbrooke's Hospital in Cambridge for about a year but resigned when their new computer system (£200M) caused major disruption to the smooth running of the hospital for several months. He was interviewed by ITV News in March this year (http://www.itv.com/news/anglia/2016-03-12/if-i-had-a-patient-that-was-going-down-as-fast-as-the-nhs-and-sat-there-twiddling-my-thumbs-id-be-struck-off/)  when he said:

"Make no mistake. The NHS is collapsing around our ears.

"If you are a clinician on the front line, trying to do your work, that's what is holding the NHS together at the moment. It's the dedication, passion and commitment of clinicians on the front ine and the system we have set up is making it increasingly difficult every day for them to do their job effectively.

"If I had a patient that was going down as fast as the NHS and sat there twiddling my thumbs, talking and discussing things, I would be struck off - quite rightly - for malpractice. It's about time we woke up."
It was time to "get on and do things'.

Prof McNeill resigned from his post ahead of the Cambridge University Hospitals Trust being placed in special measures last year. He was originally brought in as a "change agent".

He said the system had stopped him being able to make improvements and accused the NHS of having "more pilots than British Airways".[my underlining]

But he insisted he had made some progress and had gained the support of the hospital's consultants.

He also said the controversial new electronic patient record system would "provide a legacy of safety and quality for the hospital for many years to come" despite being "very disruptive and challenging" to implement.

Things are currently quiet at Addenbrooke's.

I have read Dr Robert Wachter's book "The Digital Doctor", in which he gave plenty of examples of where and how computer systems can go very seriously wrong in hospital settings. So Dr Wachter's comments on this appointment are instructive: "...I was particularly taken by Addenbrooke’s emphasis on the importance of the human-technology interface – getting this right is absolutely critical to achieving technology’s full potential.” Yet "technology's full potential" depends on many other factors too.

At the same time the data collecting project Care.data has been "paused" if not stopped by Dame Fiona Caldecott because of concerns about security and lack of transparency with respect to patients.

There are "so many pilots" of the NHS! Prof McNeil looks like a martyr. I hope he doesn't have a nervous breakdown.